Purpose Recommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment propagates individualizing resection planes. Whether significant variation exists, to warrant departure from standardized resection planes, has not been shown thus far in a large cohort of knees and with a wide range of varus deformity. The null hypothesis of this study was that there was no phenotypic variation in varus osteoarthritic knees. The aim of this paper was to determine whether distinct phenotypes could be identified, based on variations in coronal femoral and tibial morphology, which could aid in surgical planning and categorizing varus knees for future studies. Methods 2129 full-leg weightbearing radiographs were analyzed (1704 preoperative; 425 of contralateral arthritic knee). Measurements made were of HKA (hip-knee-ankle angle), VCA (valgus correction angle), mLDFA (lateral mechanical distal femoral angle), aLDFA (lateral anatomical distal femoral angle), MPTA (medial proximal tibial angle), MNSA (medial neck shaft angle), TAMA (angle between tibial mechanical and anatomical axes), and TPDR (percentage length of tibia proximal to extra-articular deformity). Results Seven distinct types were identified covering 2021 knees, reducible to 4 broad phenotypes: 11% were Type 1 'Neutral' knees showing values close to reported normal knees (mean VCA 5.5°, mLDFA 87°, aLDFA 81°). 38% were Type 2 'Intra-articular varus' with medial intra-articular bone loss (mean mLDFA 90.9°, MPTA 85.4°, VCA of 5.7°). 41% were Type 3 'Extra-articular varus' with extra-articular deformity (EAD). Type 3a had proximal tibial EAD; Type 3b had tibial diaphyseal EAD; Type 3c had femoral EAD (mean VCA 8.7°, HKA 166°), and severe medial bone loss (mean mLDFA 92°, MPTA 83°). 9% were Type 4 'Valgoid type' with features of valgus knees: Type 4a had medial femoral bowing (mean VCA 2.9°); Type 4b had significant distal femoral valgus (mean mLDFA 85.3°, aLDFA 78.6°). Conclusions The null hypothesis that there was no phenotypic variation in varus osteoarthritic knees was rejected as considerable variation was found in coronal morphology of femur and tibia. Four broad phenotypic groups could be identified. Plane of the knee joint articular surface was quite variable. This has relevance to planning and performance of corrective osteotomies, unicompartmental and total knee arthroplasty. Level of Evidence III, retrospective cohort study.

Aim:To evaluate the efficacy and safety of the retromandibular approach in the management of condylar fractures by open reduction and internal fixation (ORIF).Materials and Methods:A total of 20 patients with unilateral mandibular condylar fractures underwent ORIF using retromandibular approach. Pertinent data were collected and subjected to evaluation.Results:The retromandibular approach was found to be expeditious in adequately exposing the fracture site and enabling ORIF. The anatomic reduction of the fractured segments and the fixation was satisfactory in all the cases. Average duration of surgery was 39 min (range: 17-56 min) for satisfactory exposure, reduction, and fixation of each condylar fracture.Conclusion:The retromandibular approach provides adequate exposure of the subcondylar region and should be considered as commendable alternative in the management of condylar fractures.

Femoral neck fractures and pertrochanteric fractures are of approximately equal incidence and together make up over 90% of the proximal femur fractures and the remaining 5-10% is subtrochanteric. The femoral neck fractures are only 2% in patients with age under 50 years. After 50 years, the incidence is doubled for each subsequent decade and it is 2 to 3 times higher in women than in men. The overall annual age-standardized rates of femoral neck fractures are higher among white women than among black women. A prospective study was conducted on patients with acute fracture neck of femur aged above 60 years treated with THA in the Department of Orthopedics. Clearance from the institutional ethics committee was obtained before the study was started. An informed, written and bilingual consent was obtained before the study was started. About 40% of study subjects presented to the hospital at 2 -5 days, 35% presented on 1 st day, 17.5% presented on 6 -10 days and 7.5% presented after 10 days of fracture.

Purpose: Minimally invasive plate osteosynthesis (MIPO) is used for the treatment of distal tibial fractures, especially in cases of intra-articular fractures. There are many advantages of MIPO, including preservation of blood supply to the fracture site and enhanced bone healing, however, it is not without complication. The study aimed to elaborate the benefits of MIPO technique in managing distal tibia fractures and to describe the necessities for good union and functional outcome. Methods: A total of 38 patients with distal tibia comminuted and spiral fractures, having closed distal tibia AO/OTA 43-A, B or C fractures with or without fibular fractures, were included. All the cases were assessed for union time, complications and functional outcomes. Binomial regression using [Formula: see text] v3.6.0 was used to assess the success of MIPO based on four-cortex alignment. [Formula: see text] value [Formula: see text] was considered statistically significant. Results: The mean operative time was 70[Formula: see text]min. All 38 tibial fractures united and the mean union time was found to be 18 weeks. Five cases were noted to have complications (four superficial infections and one implant failure). Out of 38 patients, 28 (majority) showed excellent functional outcomes as assessed by the American Orthopaedic Foot and Ankle Society score, i.e. a score of [Formula: see text]90. Conclusion: MIPO is a good method for the management of tibial fractures with extra-articular and intra-articular involvement, with good union even when absolute four cortical contact is not achieved.

The purpose of this study was to demonstrate the reduced chances of iatrogenic femoral neck fracture while removing the Richard's screw using the dynamic hip screw–femur head conjoint removal technique. This retrospective cohort study analyzed 16 hips operated on with total hip arthroplasty from March 2010 to February 2015. All cases were previously treated with dynamic hip screws (DHS) for proximal femur fractures. The age of the patients ranged from 20 to 75 years. We used uncemented sockets in 15 patients and cemented sockets in 1 patient. We used conical fluted straight stems in 9 cases, ML (Mediolateral) tapered stems in 5 patients and CLS (Cementless Spotorno) stems in 2 patients. The head of the femur was removed together with the attached Richard's screw after taking a neck cut during hip replacement after previous dynamic hip screw fixation. At 2‐year follow‐up, there was a statistically significant improvement in the Harris hip score: from a mean preoperative score of 35 ± 7.975 to a mean postoperative score of 89.38 ± 4.870 (P < 0.001). Stem sinking and Type AL (Vancouver classification for periprosthetic fracture) periprosthetic fracture in 1 patient with a tapered stem was noted. Good acetabular inclination was achieved in all cases. At 2‐year follow‐up, all patients were able to carry out their daily activities. This is a novel technique with the advantage of avoiding iatrogenic femoral neck fracture in an osteoporotic bone.

<p class="abstract"><strong>Background:</strong> Fixation of distal femoral fractures with a lateral plate alone is associated with nonunion and/or malunion with varus collapse. Locking compression plates may reduce the tendency of varus collapse. Hence, we evaluated the union rates and functional and anatomical outcome in patients of distal femoral fractures who were treated with locking compression plates.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted at a tertiary health care center at Bangalore between July 2010 and June 2012. Patients with distal femoral fractures were treated with locking compression plates and were followed up for at least 6 months. Outcomes were evaluated using Neer’s score to assess outcomes in adult distal femoral fractures.<strong></strong></p><p class="abstract"><strong>Results:</strong> The study included 22 patients (10 males and 11 females) among whom one patient was lost to follow up within 6 months after the procedure. All the fractures were post-traumatic. Nineteen (91%) patients had closed fractures whereas two (9%) had open fractures. Muller’s A1 type was the most common (n=7) type of fracture followed by C2, C1, A2 (n=4 each) and B1, A3 (n= 1 each). Median duration of follow-up was 8 months (range: 6-18 months). The mean NEER’s functional score was 80 points. Overall results were excellent in 5 (24%) out of 21 cases and were satisfactory in 15 (71%) cases and only one had an unsatisfactory result.</p><p class="Style14"><strong>Conclusions:</strong> Locking compression plates offer excellent-satisfactory outcome in patients with distal femoral fractures. </p>

Case: A 37-year-old farmer presented with previously operated open type 2 infected nonunion of distal radius. A wrist-spanning external fixator was applied after implant removal, debridement, and postoperative antibiotics for 6 weeks. At 6 weeks' follow-up, a volar locking plate and bone grafting for the gap nonunion over distal radius and the modified Sauve-Kapandji procedure for distal radioulnar joint (DRUJ) were performed. The patient had excellent results at 3 years' follow-up. Conclusion: Distal radius nonunion with disrupted DRUJ can be treated with internal fixation, and the modified Sauve-Kapandji technique provided thorough debridement is performed.

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disorder of the synovium resulting in joint destruction. The knee is among the most commonly affected joints in RA and advanced arthritis of the involved joint is associated with poor prognosis contributing to patient pain and disability. In advanced disease, total knee arthroplasty (TKA) has proven to be the most successful intervention that reduces knee pain and improves physical function in RA patients. Materials and methods:A total of 34 total knee arthroplasties were performed in a tertiary care centre for rheumatoid arthritis of the knee joint with a posterior stabilized knee. Patients were regularly followed up and were assessed at the end of two years for the function of the knee joint, quality of life, ability to walk and perform routine daily activities, local signs of infection, activity of the disease and general condition. Results and conclusion:The difference in the average knee society score and the difference in the average knee available range of motion were found to be statistically significant at end of 3 years. There is a significant improvement in functional scores of the knee. However, there will be involvement of multiple joints, associated systemic complications and further progression of the disease. Because of the above said reasons overall functional outcome of the patient might not be significant improvement when compared to excellent clinical outcome of the operated knee.